针刺外关穴的脑区激活：功能磁共振成像证据

Objective: To observe the cerebral activation of needling Waiguan (SJ5) by fMRI with the controlled studies of sham needling and needling in a sham point. Methods: Eighteen volunteers were randomly divided into 3 groups of true needling in true acupoint Waiguan (SJ5)(group A), sham needling in true acupoint SJ5 (group B) and true needling in a sham point (group C). During the stimulation, each subject received fMRI functional cerebral imaging scan. The collected data were processed by SPM2.Results: Compared with sham needling, true needling in SJ5 could activate the areas of BA8 and left cerebellum; Compared with needling in the sham point, needling in SJ5 could activate the areas of BA2 and bilateral cerebellum.Conclusion: Needling in SJ5 acupoint activated different cerebral areas compared with sham needling in the same acupoint or true needling in a sham acupoint based on the scanning of fMRI cerebral functional imaging.     

Activated and deactivated functional brain areas in the Deqi state: A functional MRI study

We compared the activities of functional regions of the brain in the Deqi versus non-Deqi state, as reported by physicians and subjects during acupuncture. Twelve healthy volunteers received sham and true needling at the Waiguan (TE5) acupoint. Real-time cerebral functional MRI showed that compared with non-sensation after sham needling, true needling activated Brodmann areas 3, 6, 8, 9, 10, 11, 13, 20, 21, 37, 39, 40, 43, and 47, the head of the caudate nucleus, the parahippocampal gyrus, thalamus and red nucleus. True needling also deactivated Brodmann areas 1, 2, 3, 4, 5, 6, 7, 9, 10, 18, 24, 31, 40 and 46.     

不同穴位皮部浅刺与常规针刺在fMRI脑功能成像中的差异

Few studies have examined the effects of different stimuli at a single acupoint using functional magnetic resonance imaging.The present study applied acupuncture at the Neiguan(PC 6),Waiguan(SJ 5),Zhigou(SJ 6) and Yanglingquan(GB 34) acupoints in healthy volunteers.fMRI was used to examine the activation of brain areas in response to different types of acupuncture(cutaneous or routine acupuncture) at each acupoint.There were no significant differences in the distribution of activation in the regions of interest between cutaneous and routine acupuncture at the Neiguan,Waiguan,and Zhigou acupoints,but some differences were observed between the two methods of acupuncture at the Yanglingquan acupoint.There were no significant differences in the intensity of induced activation between cutaneous and routine acupuncture at the Neiguan,Zhigou and Yanglingquan acupoints,but the activation intensity in the right cerebellum induced by routine acupuncture at the Waiguan acupoint was greater than that induced by cutaneous acupuncture.Results confirmed that cutaneous and routine acupuncture at the Neiguan,Waiguan,Zhigou and Yanglingquan acupoints activated different functional brain areas,and caused activation of different intensities in some areas.     

Acupuncture at Waiguan (TE5) influences activation/deactivation of functional brain areas in ischemic stroke patients and healthy people A functional MRI study

In the present study, 10 patients with ischemic stroke in the left hemisphere and six healthy controls were subjected to acupuncture at right Waiguan (TE5). In ischemic stroke subjects, functional MRI showed enhanced activation in Broadmann areas 5, 6, 7, 18, 19, 24, 32, the hypothalamic inferior lobe, the mamillary body, and the ventral posterolateral nucleus of the left hemisphere, and Broadmann areas 4, 6, 7, 18, 19 and 32 of the right hemisphere, but attenuated activation of Broadmann area 13, the hypothalamic inferior lobe, the posterior lobe of the tonsil of cerebellum, and the culmen of the anterior lobe of hypophysis, in the left hemisphere and Broadmann area 13 in the right hemisphere. In ischemic stroke subjects, a number of deactivated brain areas were enhanced, including Broadmann areas 6, 11, 20, 22, 37, and 47, the culmen of the anterior lobe of hypophysis, alae lingulae cerebella, and the posterior lobe of the tonsil of cerebellum of the left hemisphere, and Broadmann areas 8, 37, 45 and 47, the culmen of the anterior lobe of hypophysis, pars tuberalis adenohypophyseos, inferior border of lentiform nucleus, lateral globus pallidus, inferior temporal gyrus, and the parahippocampal gyrus of the right hemisphere. These subjects also exhibited attenuation of a number of deactivated brain areas, including Broadmann area 7. These data suggest that acupuncture at Waiguan specifically alters brain function in regions associated with sensation, vision, and motion in ischemic stroke patients. By contrast, in normal individuals, acupuncture at Waiguan generally activates brain areas associated with insomnia and other functions.     

太溪和丘墟穴捻针时不同脑功能区的激活

A number of previous studies of acupuncture acupoint specificity have used sham acupoints,sham acupuncture or meridian acupoints at a great distance from each other as controls in functional MRI (fMRI) experiments.However,few studies have compared different meridian acupoints within the same segment,which are associated with similarly intense needle sensations.We performed fMRI on 12 healthy young volunteers and observed differences in brain activation elicited by acupuncture of the Taixi (KI 3) and Qiuxu (GB 40) acupoints.Acupuncture was applied at the Taixi and Qiuxu acupoints,using a multiple-block fMRI design with three blocks,involving three alternations of resting and task phases.After scanning,needle sensation was assessed.The behavioral results revealed that the subjective needle sensation was similar between the Taixi and Qiuxu acupoints.The fMRI results revealed that acupuncture at the right Taixi acupoint activated the right superior temporal gyrus (BA 22),left middle frontal gyrus (BA 46) and inferior frontal gyrus (BA 45),bilateral parietal lobe postcentral gyrus (BA 2),right parietal lobe (BA 3),and left parietal lobe (BA 40).Acupuncture at the right Qiuxu acupoint activated the left superior temporal gyrus (BA 42),right parietal lobe postcentral gyrus (BA 40,BA 43),right inferior frontal gyrus (BA 47),bilateral superior temporal gyrus (BA 22),and right insula BA13.These results suggest that the right Taixi and Qiuxu acupoints activated different brain areas.     

基于功能磁共振成像的脑网络图论分析及其在阿尔茨海默病中的应用

阿尔茨海默病是以进行性智能减退为特征的中枢神经系统变性疾病,目前对其病理生理学机制尚不十分清楚。近年来,利用功能磁共振成像技术结合基于图论的复杂脑网络理论,发现阿尔茨海默病患者大脑功能网络存在局部和全局拓扑性质异常改变,这不仅为了解其病理生理学机制提供了新视角,也可能为早期诊断寻找到新的影像学标志。本文主要介绍复杂脑网络理论的基本概念,回顾近年来人脑功能网络在阿尔茨海默病中的研究进展,尤其是"小世界"网络模型的研究,并提出存在的问题及未来研究方向。     

rTMS对aMCI患者认知功能的影响及对脑网络的调控作用

目的:观察重复经颅磁刺激(rTMS)对遗忘型轻度认知功能障碍(aMCI)患者认知功能的影响及对脑网络的调控作用.方法:将30例aMCI患者随机分为rTMS组(真刺激组)15例和rTMS假刺激组(假刺激组)15例.进行蒙特利尔认知评估量表(MoCA)、临床记忆量表(CMS)测试,采集结构性磁共振成像(sMRI),同时真刺激组采集其静息态功能磁共震成像(fMRI)数据;磁刺激参数:刺激部位为左侧额叶背外侧皮质(dlPFC),强度为RMT的90％,频率为15 Hz,每日20个序列,间隔时间25 s,5d为1个疗程,连续治疗2个疗程.rTMS治疗结束后再次进行量表测试,采集真刺激组fMRI数据.比较两组治疗前后的MoCA、CMS测试结果;分析以左侧dlPFC为感兴趣区域(ROI)的功能性连接情况.结果:①rTMS对aMCI的认知能力有改善作用;②真刺激组治疗后右侧额中、左侧三角部额下回、双侧丘脑等多个脑区与左侧dlPFC功能性连接增强,右侧补充运动区等脑区连接降低.结论:高频rT-MS对aMCI患者的默认模式网络(DMN)有修复作用.     

针刺穴位的脑功能磁共振成像研究——针刺中渚穴和阳陵泉穴与大脑皮质兴奋性的关系

目的 应用功能性磁共振成像(fMRI)技术观察针刺手少阳经中渚穴(SJ3)和足少阳经阳陵泉穴(GB34)时大脑皮质兴奋区的分布特点,初步探讨经络、穴位作用的中枢机制以及针刺穴位过程中,不同针灸刺激时相对大脑皮质兴奋性的影响.方法 将42例健康受试者(右利手)随机分为SJ3和GB34两组,利用fMRI技术实时动态扫描针刺SJ3和GB34时脑功能区的变化,最终所获得的数据采用SPM2软件包分析其作用部位.结果 针刺SJ3引起的脑内主要兴奋区依次为双侧的额叶、颞叶、小脑和枕叶,针刺GB34引起的主要兴奋区依次为双侧的枕叶、小脑、额叶和颞叶.结论 针刺SJ3和GB34时均可引起双侧听觉、视觉相关大脑皮质和双侧躯体运动区大脑皮质及小脑兴奋,这可能是临床治疗相关病症的中枢作用基础.     

精神分裂症患者发病年龄与静息态脑功能局部一致性的关系

目的探讨精神分裂症患者发病年龄与静息态脑功能局部一致性(Re Ho)之间的关系。方法选取19名45~59岁符合《精神障碍诊断与统计手册(第4版)》(DSM-Ⅳ)精神分裂症诊断标准的精神分裂症患者为被试。以发病年龄25岁为分界线,将患者分为25岁之前发病的早期发病患者组9名和25岁之后发病的晚期发病患者组10名,采集静息态功能磁共振数据,对比两组Re Ho值。结果相对于早期发病的精神分裂症患者,晚期发病组大脑右侧额上回处的Re Ho值显著降低(P0.01,簇大小486mm3)。同时,右侧额上回处的Re Ho均值与精神分裂症病程呈正相关,即个体病程越短,该脑区的Re Ho值越低。结论患者发病年龄越早、病程越长,对右侧额上回功能同步性越明显。     

不同MR扫描序列对脑内移植SPIO标记神经干细胞大鼠的成像对比研究

目的比较3种不同MR扫描序列对脑内移植的超顺磁性氧化铁(SPIO)示踪标记神经干细胞显示作用的优劣,找出最佳扫描方案.方法将SPIO标记的神经干细胞移植到大鼠脑内,制备动物移植模型.行MR扫描,扫描序列包括SE T2WI(TR 6 000 ms,TE 100ms)、FSE T2WI(TR 2 200ms,TE 90 ms)和GRE T2*WI(TR 500ms,TE 30 ms),分析3种扫描序列在SPIO标记神经干细胞移植大鼠脑的显像特征,并进行病理学检查对照分析.结果3种扫描序列均示靶点(标)信号强度较靶点(未)有不同程度的下降,而且靶点(标)的信号强度衰减率(PSIL)在GRE T2*WI明显高于其他序列,SE T2WI、FSE T2WI中靶点(标)之间PSIL没有显著性差异;3种扫描序列中靶点(未)的信号与正常脑组织信号没有显著性差别.结论SPIO标记的神经干细胞移植到大鼠脑内后,3种MRI扫描序列显像中以GRET2*WI最为敏感.     

Three Years On Clomipramine: Before and After Brain SPECT Study

A case is presented of a patient diagnosed with attention deficit disorder, obsessive thinking, anger outbursts, and depression who had a SPECT study prior to treatment and after 3 years of treatment on clomipramine. The follow-up SPECT study showed marked improvement overall in the cerebral perfusion of the brain. At rest marked overactivity was noted in the anterior medial aspects of the frontal lobes, along with patchy (increased and decreased) uptake throughout the cortical and subcortical areas of the brain. After treatment for 3 years on clomipramine at 225 mg a day, the follow-up SPECT study revealed a normalization of activity in the anterior medial aspects of the frontal lobes as well as no patchy uptake cortically and subcortically as noted in the study prior to treatment. The clinical usefulness of the SPECT study as it relates to this case is discussed.     

High-Resolution Brain SPECT Imaging in ADHD

Children and adolescents with ADHD were evaluated with high-resolution brain SPECT imaging to determine if there were similarities between reported PET and QEEG findings. Fifty-four children and adolescents with ADHD by DSM-III-R and Conners Rating Scale criteria were evaluated. A non-ADHD control group was also studied with SPECT. Two brain SPECT studies were done on each group, a resting study and an intellectual stress study done while participants were doing a concentration task. Sixty-five percent of the ADHD group revealed decreased perfusion in the prefrontal cortex with intellectual stress, compared to only 5% of the control group. These are findings consistent with PET and QEEG findings. Of the ADHD group who did not show decreased perfusion, two-thirds had markedly decreased activity in the prefrontal cortices at rest.     

Palinopsia and perilesional hyperperfusion following subcortical hemorrhage

We report a patient who exhibited transient palinopsia and visual hallucinations. Disturbances initially included an auditory component and increasingly were localized to the left visual field. These events occurred during recovery from a right subcortical hematoma with left homonymous hemianopia. Single-photon emission computed tomography (SPECT) demonstrated extensive perilesional hyperperfusion involving parts of the right parietal, temporal, and occipital cortex. Perilesional hyperperfusion disappeared as the visual abnormalities diminished. We believe that excitatory neuronal activation in perilesional cortex during recovery contributed importantly to the transient abnormal perceptions.     

阿尔茨海默病的影像学研究进展

阿尔茨海默病(AD)是一种起病隐匿的进行性发展的神经系统退行性疾病,临床上以记忆减退、人格和行为障碍、认知功能和精神障碍等表现为特征,并伴有神经炎性斑块和神经原纤维缠结的典型病理学改变。目前临床常用的计算机断层扫描和磁共振成像等结构影像学技术,仅能发现出现了脑组织结构改变的AD患者,但无法实现疾病的早期和超早期诊断。功能影像学和分子影像学分别能从功能水平和分子水平评估AD的发展进程和变化,功能影像学技术包括CT灌注成像、功能磁共振成像和动脉自旋标记等,通过检测局部脑组织血流灌注的变化来评价大脑活动和功能的改变,对诊断临床前AD有着指示性作用。分子影像学技术包括正电子发射断层扫描、单光子发射计算机断层扫描、磁共振波谱成像等,在确定AD标志性生物靶点的基础上,开发出相应的放射性示踪剂,识别和结合AD特征性病理分子,从细胞层面的病理变化实现AD早期发现。相比于结构和功能影像学,分子影像学技术对AD早期发现、分级评估、治疗效果预测有着更大的作用,为阐明发病机制、研发药物新靶点提供了全新的技术路径。该文概述了AD各类影像学技术的最新研究进展,分析了相关技术的临床和科研价值,并评价不同技术的优缺点...     

Needling at the Waiguan (SJ5) in healthy limbs deactivated functional brain areas in ischemic stroke patients A functional magnetic resonance imaging study

Deactivation is common in cerebral functional imaging. However, the physiological mechanisms responsible for this phenomenon remain poorly understood. The present study analyzed 12 ischemic stroke patients, who were randomly assigned to two groups: one group underwent sham needling and true needling at the Waiguan (SJ 5) in the healthy upper limb and the other group underwent sham and true needling at a sham point. Functional magnetic resonance imaging results showed no activation points in brain tissues fo...     

小脑共济失调为主要症状的多系统萎缩患者脑99mTc-SPECT影像学特征分析

目的探讨小脑共济失调症状为主的多系统萎缩(MSA-C)患者的脑局部血流量水平变化规律。方法以在我院神经内科就诊的12例MSA-C患者与25名正常对照者为研究对象,进行锝[~(99m)Tc]双半胱乙酯为显像剂的脑单光子发射计算机断层成像(SPECT)检查以评价脑局部血流量,其SPECT影像以SPM8、xjview9软件进行基于体素的形态学分析(VBM),将与正常对照在脑局部血流量有上统计学差异的区域投射至标准脑模版上,并分析其主要累及脑区、峰值位置、最大t值等特征。结果与正常对照者相比较,MSA-C患者主要出现小脑双侧小脑后叶、小脑蚓部、脑桥的脑局部血流量显著下降(P 0. 01FDR校正,簇水平);未发现有明显统计学意义上的大脑皮质及壳核的脑局部血流量降低。结论 MSA-C患者主要可出现小脑及脑桥的脑局部血流量降低。     

Radiological biomarkers for diagnosis in PSP: Where are we and where do we need to be?

PSP is a pathologically defined neurodegenerative tauopathy with a variety of clinical presentations including typical Richardson's syndrome and other variant PSP syndromes. A large body of neuroimaging research has been conducted over the past two decades, with many studies proposing different structural MRI and molecular PET/SPECT biomarkers for PSP. These include measures of brainstem, cortical and striatal atrophy, diffusion weighted and diffusion tensor imaging abnormalities, [18F] fluorodeoxyglucose PET hypometabolism, reductions in striatal dopamine imaging and, most recently, PET imaging with ligands that bind to tau. Our aim was to critically evaluate the degree to which structural and molecular neuroimaging metrics fulfill criteria for diagnostic biomarkers of PSP. We queried the PubMed, Cochrane, Medline, and PSYCInfo databases for original research articles published in English over the past 20 years using postmortem diagnosis or the NINDS‐SPSP criteria as the diagnostic standard from 1996 to 2016. We define a five‐level theoretical construct for the utility of neuroimaging biomarkers in PSP, with level 1 representing group‐level findings, level 2 representing biomarkers with demonstrable individual‐level diagnostic utility, level 3 representing biomarkers for early disease, level 4 representing surrogate biomarkers of PSP pathology, and level 5 representing definitive PSP biomarkers of PSP pathology. We discuss the degree to which each of the currently available biomarkers fit into this theoretical construct, consider the role of biomarkers in the diagnosis of Richardson's syndrome, variant PSP syndromes and autopsy confirmed PSP, and emphasize current shortfalls in the field. © 2017 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.